They can lay you low, render you immobile and limit your game. They can make the mere act of turning your head piercingly painful. "They" are back spasms and perhaps worst of all, they have a tendency to strike anyone at any time. "A lot of back spasms happen after an activity, not during," says Dr. Robert Watkins, a member of the Association of Professional Team Physicians (PTP) and a spinal consultant for many Los Angeles-based teams. "You can be reaching for a light switch or a rebound."

Join Dr. Watkins as he explores the nature of back spasms -- what they are, how they may be treated and steps that can be taken to prevent them from coming back to your back.

What are back spasms?

Dr. Watkins: Back spasms are a contraction of the back muscles in response to a stress on the spine. Usually, one of the structures of the spine such as a joint or one of the ligaments of the spine is injured. The nerves that supply the sensory information to the injured area -- the nerves that pick up the sensation of pain -- are also connected to the nerves that control the muscles of the back. So the stimulus from an actual spine injury will cause the surrounding muscle of the back to contract -- that is the spasm. It's really the body's way of protecting an injured area from further damage. The way to think about back spasms is that they are like a fever you get when you have an infection. Just as a fever is symptomatic of an underlying infection, so it is that back spasms are a result of some type of inflammation in the spine. In the same way we use aspirin to reduce the fever but take antibiotics to treat the infection, we might take muscle relaxants to address the spasms but need to use anti-inflammatories to reduce the inflammation. It may not seem very efficient, and it certainly can be painful, but pain, like fever, is an effective warning signal.

What triggers back spasms?

Dr. Watkins: They usually are the result of a sudden or extended trauma upon the spine or the muscles supporting the spine. For example, an athlete can change his training regimen or overextend himself, which could lead to a muscle or ligament strain and subsequent spasm. At the other end of the spectrum, you may be on a long airplane flight in a cramped, uncomfortable seat and your muscles could be forced into an unfamiliar position. Once you stand up, those strained muscles can trigger a spasm.

Stress can also be a contributing factor. When you are stressed, you're often unconsciously clenching your shoulders or teeth. This is counterproductive to the normal motion of the joint. The joint is in a position like that of the airline seat and the results, unfortunately, can be similar.

Most spasms affect the paraspinal musculature -- the muscles running from the base of the skull to the pelvis on either side of the backbone. They are the muscles most commonly "thrown out," and often the mere act of sitting up or turning to the side can be excruciatingly painful.

How are back spasms treated?

Dr. Watkins: You have to treat the underlying process or cause. So you must address the inflammation of the spine. We treat back spasms with rest, ice, anti-inflammatory medications and specifically designed exercises that can help strengthen the support of the injured joint. There are a whole group of muscle relaxants that are used, but we really de-emphasize those kinds of medications in favor of anti-inflammatories to eliminate the underlying cause. Most muscle relaxants are like mild tranquilizers that don't really accomplish muscle relaxation in terms of treating or preventing muscle spasms.

ASSOCIATION OF PROFESSIONAL TEAM PHYSICIANS

ASK THE PRO DOC

Q: What is a Baker's cyst, how does it occur (in the knee), and can
it affect athletic participation?
-- Brandon, OH

A: From Dr. Bruce Moseley, team physician for the Houston Rockets:
"A Baker's cyst is a collection of fluid behind the knee. The fluid is
contained in an outgrowth of the lining of the knee called the capsule. A
Baker's cyst occurs when something causes fluid to accumulate within the
knee, and as the pressure from the fluid builds, it pushes its way to the
back of the knee in a weakened area of the capsule. It can definitely
affect athletic participation.

The main question about a Baker's cyst is why the fluid begins accumulating
in the knee in the first place. Classically, a Baker's cyst is associated
with arthritis in the knee, but other things such as a meniscus cartilage
tear, inflammation of the synovial lining of the knee, etc.,can also cause
the fluid to accumulate. The treatment for the cyst is to figure out the
cause of the fluid accumulation and to treat it. A visit to your orthopedic
surgeon will help straighten this out."

When some people talk about a "crick in their neck," there may be some role for spinal manipulation where a skilled, licensed health care provider can free up the motion in a joint that is having residual spasms.

Can back spasms be prevented?

Dr. Watkins: Besides addressing the underlying causes of spasms, we feel strongly about a preventative exercise program specifically designed to restore normal health and motion to the joints. This helps to provide coordinated muscle strength to ensure the joint works properly at all times even when you're not thinking about it. And just as the treatment for an inflamed back would be the same as the treatment for an inflamed knee, you would want to build up coordinated muscle strength in your spine just as you would your injured knee.

Many times, back spasms occur after an activity. You play a sport, sit down for a while, stand up and stretch and it hits you. This is why one of the most important post-exercise things you can do is to maintain proper posture. When you come in from a golf game, you need to sit properly in a chair in the clubhouse if you don't want to experience stiffness or worse when you stand. Proper posture involves a chest-out, head-up alignment.

As far as stretching is concerned, we de-emphasize stretching in the initial treatment program because too often it involves taking the joints of the spine through a range of motion that it is not prepared to handle. This can cause further injury not only in the spasming muscles but also to the underlying structure. Once you've established muscle control of the spine through a conditioning and strengthening program, you can and should stretch your back and its extremities including the hamstrings and hip flexors and abdominals. This is especially important when warming up for activities. So in short, in terms of treatment, stretching is not emphasized. In terms of prevention, when the condition is not present, stretching is of equal importance to strengthening.

Dr. Robert G. Watkins , a member of the Association of Professional Team Physicians (PTP), heads the Center for Orthopaedic Spinal Surgery in Los Angeles, Calif. Dr. Watkins received his medical degree from the University of Tennessee Medical School in Memphis and did his internship and residency at the University of Southern California School of Medicine in Los Angeles. Dr. Watkins also is currently a Professor of Clinical Orthopedic Surgery at USC.

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